USMLE Step 1 Pass Rate 2026: Stats by MD, DO, IMG

The USMLE Step 1 first-time pass rate sits at 93% for US MD students, 89% for DO students, and 75% for IMGs based on the most recent NBME performance data (USMLE Performance Data, 2025 reporting period).

Those headline numbers hide important details. Retake pass rates are significantly lower. The pass/fail transition created a temporary dip across all groups. And your individual probability depends on your NBME practice scores far more than on which group you belong to.

Key Takeaways

• First-time pass rates: 93% US MD, 89% US DO, 75% IMG (USMLE Performance Data, 2025).
• Retake pass rates drop to 50–70% across all groups.
• The passing threshold remains at 196 on the internal scaled score (roughly 60–65% correct).
• You get a maximum of 4 lifetime attempts, with no more than 3 in any 12-month period.

Current USMLE Step 1 Pass Rates

Here's how first-time test takers performed in the most recent reporting period:

Full Pass Rate Table

Source: USMLE Performance Data, 2025. Note: US citizen IMGs historically outperform non-US citizen IMGs by 5–8 percentage points.

How Have Pass Rates Changed Over Time?

The transition to Pass/Fail scoring in January 2022 created a noticeable dip in pass rates across all groups. The theory: some candidates who previously would have scored in the low 200s (a pass, but not by much) are now putting in less preparation effort because there's no numerical score to optimize.

Historical First-Time Pass Rates: US MD Seniors

Source: NBME Annual Reports and FSMB published performance summaries.

The 3-point drop from 96% to 93% might not look dramatic, but it represents hundreds of additional students failing each year nationally.

Why Do IMG Pass Rates Differ?

The 75% IMG pass rate doesn't mean IMGs are less capable. The gap exists because of structural factors:

Curriculum differences. Many international medical schools focus on clinical training earlier and basic science integration later. Step 1 is specifically designed around the US preclinical model — organ system-based basic science with clinical vignette application.

Resource access. US medical students typically have UWorld, First Aid, and Anki integrated into their curriculum from year one. Many IMGs discover these resources later in their preparation.

Language and vignette style. Step 1 clinical vignettes follow a specific NBME writing pattern — long stems with embedded clues. If you didn't train with this format, you lose time parsing the question before you can even apply your knowledge.

Time since basic sciences. IMGs who graduated years before taking Step 1 face significant content decay, especially in subjects like biochemistry and pharmacology that require rote recall.

If you're an IMG, budget an extra 2–4 weeks of dedicated preparation compared to US students, focus heavily on QBank practice to build NBME-style reasoning, and use NBME self-assessments to benchmark your readiness before scheduling.

For details on IMG eligibility and ECFMG registration, see our USMLE Step 1 Registration Guide.

What Happens If You Fail?

A failed attempt stays on your USMLE transcript permanently. You cannot hide it, and residency program directors will see it when they access your USMLE scores through ERAS or NRMP.

Retake Rules

• Maximum 3 attempts within any 12-month period.
• Maximum 4 attempts total, lifetime.
• Each failed attempt is recorded with the date.
• You must wait at least 1 month between attempts (and many testing windows fill up, making the practical wait 2–3 months).

Retake Success Strategy

If you failed, don't rush your retake. Most students who fail need 8–12 additional weeks of focused preparation — not a quick 2-week review.

Analyze your NBME performance profile to identify your weakest content areas. Build a targeted study plan around those gaps. Take at least 2 fresh NBME self-assessments before rescheduling, and don't book your exam date until you're consistently scoring above 70% on practice forms.

For practice exam interpretation, see our NBME Self-Assessment & Free 120 Score Guide.

How to Predict Your Own Pass Probability

Your personal pass rate depends on your NBME practice exam scores, not on population statistics.

Take NBME forms 25–31 during your dedicated study period. These are the most accurate predictors of exam day performance. The Free 120 from USMLE.org tests the same content in the official exam interface.

For a complete walkthrough of NBME forms and Free 120 score interpretation, see our NBME & Free 120 Score Guide.

Does Pass/Fail Mean Step 1 Doesn't Matter?

No. Pass/Fail removed the score comparison, but it didn't remove the consequences of failing. A failed Step 1 attempt is still one of the strongest negative signals in a residency application.

And here's what people forget: the knowledge you build studying for Step 1 directly feeds into Step 2 CK performance — which is still numerically scored and heavily weighted by program directors. A weak Step 1 foundation means a lower Step 2 CK score, which now carries even more weight in the application cycle.

For an overview of the full exam format and preparation strategy, read our Complete USMLE Step 1 Guide.

Frequently Asked Questions

What is the USMLE Step 1 passing score?

The internal passing threshold is 196 on the three-digit scaled score. This roughly corresponds to 60–65% of scored questions answered correctly. Your result is reported as Pass or Fail only — you won't see a number.

What percentage of medical students pass Step 1?

About 93% of US MD students and 89% of US DO students pass on their first attempt. The overall first-time pass rate across all groups is approximately 88%.

How many times can you retake USMLE Step 1?

You can take Step 1 up to 3 times within a 12-month period and 4 times total in your lifetime. Each attempt, whether you pass or fail, is recorded on your permanent USMLE transcript.

Are Step 1 pass rates going down?

Pass rates dropped 2–3 percentage points for US MD students after the switch to pass/fail scoring in 2022. They've since stabilized around 92–93%. The theory is that some students reduced their preparation effort once numerical scores were removed.

What is the IMG pass rate for Step 1?

The overall IMG first-time pass rate is approximately 75%. US citizen IMGs pass at about 78%, while non-US citizen IMGs pass at about 72%. The gap is attributed to curriculum differences, resource access, and familiarity with the NBME question style.